Thallium-201 myocardial SPECT in Bland-White-Garland syndrome: two adult patients with inferoposterior perfusion defect.

A myocardial 201TI SPECT examination was conducted both prior to and following surgery of two adult patients with an anomalous left coronary artery originating from the pulmonary artery (Bland-White-Garland syndrome). In this syndrome, the anterior wall is usually affected first. Preoperative examination demonstrated an inferoposterior perfusion defect. In both patients, the right coronary artery was markedly dilated, and a significant left-to-right shunt formation was observed. Both patients were diagnosed as possibly having coronary steal syndrome. A prolonged inadequate blood supply to the right coronary region may cause inferoposterior cardiomyopathy. In the postoperative examination, myocardial perfusion markedly improved in one patient whose preoperative SPECT showed redistribution in a delayed scan. Thallium-201 SPECT was therefore found to be useful in assessing both the preoperative and postoperative myocardial perfusion.